Provider Demographics
NPI:1093147217
Name:SHAH, NIDHI GIRISHCHANDRA (MD)
Entity Type:Individual
Prefix:
First Name:NIDHI
Middle Name:GIRISHCHANDRA
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5576
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-5576
Mailing Address - Country:US
Mailing Address - Phone:432-570-0238
Mailing Address - Fax:432-699-3815
Practice Address - Street 1:4214 ANDREWS HWY STE 310
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-4822
Practice Address - Country:US
Practice Address - Phone:432-697-4747
Practice Address - Fax:432-699-3813
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD458728208000000X
390200000X
TXS9223208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program